Individual provider Active NPI

Jeensoo Chang, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1699046656
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.129144 Issued in IL
Practice address
1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone
(312) 942-7030
Fax
(312) 563-4212
NPI assigned
Jan 23, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.129144 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
Chicago, IL 60612-3833

Mailing address

1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone (312) 942-7030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130626000610 IL Practitioner - Family Practice 6608015425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

1401 S California Ave
Chicago, IL 60608-1858
Phone (773) 522-6656

California Ave at 15TH St
Chicago, IL 60608-1858
Phone (773) 542-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.03 of 100Reported as group
Quality
71.53
Promoting interoperability
100
Improvement activities
40
Cost
76.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.129144ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Community Foundation CurrentSince Feb 1, 2015 Accepting new patients
Mount Sinai Community Foundation Current Accepting new patients
Mount Sinai Community Foundation CurrentSince Feb 1, 2015 Accepting new patients

Locations

2320 E 93rd St
Chicago, IL 60617
Phone (773) 967-2000

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

2701 W 68th St
Chicago, IL 60629
Phone (773) 471-8000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1699046656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-7030",
            "fax_number": "312-563-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-7030",
            "fax_number": "312-563-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JEENSOO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-23",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.129144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.